Provider Demographics
NPI:1861468019
Name:NEWMAN, NATHAN P (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:P
Last Name:NEWMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8711 PERIMETER PARK BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6388
Mailing Address - Country:US
Mailing Address - Phone:904-223-2320
Mailing Address - Fax:904-223-3149
Practice Address - Street 1:8711 PERIMETER PARK BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6388
Practice Address - Country:US
Practice Address - Phone:904-223-2320
Practice Address - Fax:904-223-3149
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055119207Q00000X
FLME55119207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL258804400Medicaid
FL08284UMedicare PIN
FLU21474Medicare UPIN
FL08284VMedicare ID - Type Unspecified99262B
FL08284WMedicare ID - Type Unspecified99262
FL08284TMedicare PIN
FL258804400Medicaid